| National Provider Identifier [NPI]: | 1366417610 |
| Last Name Of The Provider | VANEPPS |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4516 N ARMENIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336032732 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 305 |
| Number Of Services | 6384 |
| Number Of Medicare Beneficiaries | 1742 |
| Total Submitted Charge Amount | 978821 |
| Total Medicare Allowed Amount | 211501.48 |
| Total Medicare Payment Amount | 162962.22 |
| Total Medicare Standardized Payment Amount | 161391.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3375 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 9489 |
| Total Drug Medicare AllowedAmount | 735.89 |
| Total Drug Medicare PaymentAmount | 545.95 |
| Total Drug Medicare Standardized Payment Amount | 545.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 303 |
| Number Of Medical Services | 3009 |
| Number Of Medicare Beneficiaries With Medical Services | 1740 |
| Total Medical Submitted Charge Amount | 969332 |
| Total Medical Medicare Allowed Amount | 210765.59 |
| Total Medical Medicare Payment Amount | 162416.27 |
| Total Medical Medicare Standardized Payment Amount | 160845.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 315 |
| Number Of Beneficiaries Age 65 to 74 | 536 |
| Number Of Beneficiaries Age 75 to 84 | 520 |
| Number Of Beneficiaries Age Greater 84 | 371 |
| Number Of Female Beneficiaries | 1003 |
| Number Of Male Beneficiaries | 739 |
| Number Of Non Hispanic White Beneficiaries | 1090 |
| Number Of Black or African American Beneficiaries | 236 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 383 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1068 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 674 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.315 |